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Semin intervent Radiol 2022; 39(02): 194-202
DOI: 10.1055/s-0042-1745800
How I Do It

Emborrhoid: Rectal Artery Embolization for Hemorrhoid Disease

Julien Panneau
1   Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France
2   Aix Marseille University, LIIE, Marseille, France
3   Aix Marseille University, CERIMED, Marseille, France
,
Diane Mege
4   Department of Visceral Surgery, Aix-Marseille University, Hôpital de la Timone, Marseille, France
,
Mathieu Di Biseglie
1   Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France
2   Aix Marseille University, LIIE, Marseille, France
3   Aix Marseille University, CERIMED, Marseille, France
,
Julie Duclos
4   Department of Visceral Surgery, Aix-Marseille University, Hôpital de la Timone, Marseille, France
,
Paul Habert
1   Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France
2   Aix Marseille University, LIIE, Marseille, France
3   Aix Marseille University, CERIMED, Marseille, France
,
Vincent Vidal
1   Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France
2   Aix Marseille University, LIIE, Marseille, France
3   Aix Marseille University, CERIMED, Marseille, France
,
Farouk Tradi
1   Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France
2   Aix Marseille University, LIIE, Marseille, France
3   Aix Marseille University, CERIMED, Marseille, France
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Hemorrhoids are a common anorectal disease, defined as the enlargement and symptomatic prolapse of the hemorrhoidal cushions. It affects millions of people around the world and is a major medical and socioeconomic problem.

In recent years, an improved anatomical understanding and the need to develop minimally invasive approaches have led to the development of the Doppler-guided hemorrhoidal artery ligation (DG-HAL) procedure as an effective treatment for hemorrhoids.[1]

The DG-HAL procedure uses dedicated equipment and involves the identification of hemorrhoidal arteries using Doppler ultrasound, and their ligation to decrease the flow of arterial blood to the hemorrhoidal cushions. This procedure is performed via the transanal route under local anesthesia.

This technique has several advantages: it leaves the hemorrhoidal tissue in place, preserves anal continence, and is significantly less painful and less prone to complications than open surgery, allowing patients to return to work sooner.[2]

Based on the underlying principles of this technique, we have developed the “emborrhoid” embolization technique, in which endovascular occlusion of the arteries from the distal branches of the inferior mesenteric artery (IMA) is performed. Our preliminary results for this technique have been reported in other publications.[3] [4] [5] [6] [7] [8] [9] [10]

Compared with DG-HAL, the endovascular approach offers the advantage of identifying all the hemorrhoidal arterial branches, recognizing anatomical variations, and ensuring effective occlusion of the target branches, which could improve therapeutic results. No comparative study between the two techniques has yet been performed.

The aim of this article is to describe our team's current methods and results for the emborrhoid technique as the main alternative treatment for patients with hemorrhoids.



Publication History

Article published online:
30 June 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Popov V, Yonkov A, Arabadzhieva E. et al. Doppler-guided transanal hemorrhoidal dearterilization versus conventional hemorrhoidectomy for treatment of hemorrhoids - early and long-term postoperative results. BMC Surg 2019; 19 (01) 4
    CrossrefPubMedGoogle Scholar
  • 2 Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S. Doppler-guided hemorrhoidal artery ligation. Am J Surg 2006; 191 (01) 89-93
    CrossrefPubMedGoogle Scholar
  • 3 Vidal V, Louis G, Bartoli JM, Sielezneff I. Embolization of the hemorrhoidal arteries (the emborrhoid technique): a new concept and challenge for interventional radiology. Diagn Interv Imaging 2014; 95 (03) 307-315
    CrossrefPubMedGoogle Scholar
  • 4 Vidal V, Sapoval M, Sielezneff Y. et al. Emborrhoid: a new concept for the treatment of hemorrhoids with arterial embolization: the first 14 cases. Cardiovasc Intervent Radiol 2015; 38 (01) 72-78
    CrossrefPubMedGoogle Scholar
  • 5 Tradi F, Louis G, Giorgi R. et al. Embolization of the superior rectal arteries for hemorrhoidal disease: prospective results in 25 patients. J Vasc Interv Radiol 2018; 29 (06) 884-892.e1
    CrossrefPubMedGoogle Scholar
  • 6 Moussa N, Bonnet B, Pereira H. et al. Mid-term results of superior rectal artery and coils for hemorrhoidal embolization with particles bleeding. Cardiovasc Intervent Radiol 2020; 43 (07) 1062-1069
    CrossrefPubMedGoogle Scholar
  • 7 Moggia E, Talamo G, Gallo G. et al. Do we have another option to treat bleeding hemorrhoids? The emborrhoid technique: experience in 16 patients. Rev Recent Clin Trials 2021; 16 (01) 81-86
    CrossrefPubMedGoogle Scholar
  • 8 Moussa N, Sielezneff I, Sapoval M. et al. Embolization of the superior rectal arteries for chronic bleeding due to haemorrhoidal disease. Colorectal Dis 2017; 19 (02) 194-199
    CrossrefPubMedGoogle Scholar
  • 9 Sirakaya M, O'Balogun A, Kassamali RH. Superior rectal artery embolization for hemorrhoids: what do we know so far?. Cardiovasc Intervent Radiol 2021; 44 (05) 675-685
    CrossrefPubMedGoogle Scholar
  • 10 Zakharchenko A, Kaitoukov Y, Vinnik Y. et al. Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique). Diagn Interv Imaging 2016; 97 (11) 1079-1084
    CrossrefPubMedGoogle Scholar
  • 11 Stelzner F, Staubesand J, MacHleidt H. [The corpus cavernosum recti–basis of internal hemorrhoids. [in German]. Langenbecks Arch Klin Chir Ver Dtsch Z Chir 1962; 299: 302-312
    PubMedGoogle Scholar
  • 12 Miller R, Bartolo DC, Roe A, Cervero F, Mortensen NJ. Anal sensation and the continence mechanism. Dis Colon Rectum 1988; 31 (06) 433-438
    CrossrefPubMedGoogle Scholar
  • 13 Aigner F, Bodner G, Gruber H. et al. The vascular nature of hemorrhoids. J Gastrointest Surg 2006; 10 (07) 1044-1050
    CrossrefPubMedGoogle Scholar
  • 14 Bilhim T, Pereira JA, Tinto HR. et al. Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography. Surg Radiol Anat 2013; 35 (06) 517-522
    CrossrefPubMedGoogle Scholar
  • 15 Kiyomatsu T, Ishihara S, Murono K. et al. Anatomy of the middle rectal artery: a review of the historical literature. Surg Today 2017; 47 (01) 14-19
    CrossrefPubMedGoogle Scholar
  • 16 Patrício J, Bernades A, Nuno D, Falcão F, Silveira L. Surgical anatomy of the arterial blood-supply of the human rectum. Surg Radiol Anat 1988; 10 (01) 71-75
    CrossrefPubMedGoogle Scholar
  • 17 Ke J, Cai J, Wen X. et al. Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography: insights into rectal cancer surgery - a retrospective observational study. Int J Surg 2017; 41: 106-111
    CrossrefPubMedGoogle Scholar
  • 18 Hall JF. Modern management of hemorrhoidal disease. Gastroenterol Clin North Am 2013; 42 (04) 759-772
    CrossrefPubMedGoogle Scholar
  • 19 Fathallah N, Beaussier H, Chatellier G. et al. Proposal for a new score: hemorrhoidal bleeding score. Ann Coloproctol 2021; 37 (05) 311-317
    CrossrefPubMedGoogle Scholar
  • 20 Jacobs DM, Bubrick MP, Onstad GR, Hitchcock CR. The relationship of hemorrhoids to portal hypertension. Dis Colon Rectum 1980; 23 (08) 567-569
    CrossrefPubMedGoogle Scholar
  • 21 Bernstein WC. What are hemorrhoids and what is their relationship to the portal venous system?. Dis Colon Rectum 1983; 26 (12) 829-834
    CrossrefPubMedGoogle Scholar
  • 22 Miyamoto H, Asanoma M, Miyamoto H, Takasu C, Masamune K, Shimada M. Visualization and hypervascularization of the haemorrhoidal plexus in vivo using power Doppler imaging transanal ultrasonography and three-dimensional power Doppler angiography. Colorectal Dis 2013; 15 (11) e686-e691
    CrossrefPubMedGoogle Scholar
  • 23 Snelling BM, Sur S, Shah SS, Marlow MM, Cohen MG, Peterson EC. Transradial access: lessons learned from cardiology. J Neurointerv Surg 2018; 10 (05) 487-492
    CrossrefPubMedGoogle Scholar